Kinetics of plasma biomarkers of inflammation and lung injury in surgical patients with or without postoperative pulmonary complications

BACKGROUND: Postoperative pulmonary complications (PPCs) are common after major abdominal surgery. The kinetics of plasma biomarkers could improve identification of patients developing PPCs, but the kinetics may depend on intraoperative ventilator settings. OBJECTIVE: To test whether the kinetics of plasma biomarkers are capable of identifying patients who will develop PPCs, and whether the kinetics depend on the intraoperative level of positive end-expiratory pressure (PEEP). DESIGN: A preplanned substudy of a randomised controlled trial. SETTING: Operation room of five centres. PATIENTS: Two hundred and forty-two adult patients scheduled for abdominal surgery at risk of developing PPCs. INTERVENTIONS: High (12 cmH2O) versus low (≤2 cmH2O) levels of PEEP. MAIN OUTCOME MEASURES: Individual PPCs were combined as a composite endpoint. Plasma samples were collected before surgery, directly after surgery and on the fifth postoperative day. The levels of the following were measured: tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8, the soluble form of the Receptor for Advanced Glycation End–products (sRAGE), Surfactant Protein (SP)-D, Clara Cell protein (CC)-16 and Krebs von den Lungen 6 (KL6). RESULTS: Blood sampling was complete in 242 patients: 120 patients in the high PEEP group and 122 patients in the low PEEP group. Increases in plasma levels of TNF- IL-6, IL-8 and CC-16, and a decrease in plasma levels of SP-D were greater in patients who developed PPCs; however, the area under the receiver operating characteristic curve was low for all biomarkers. CC-16 was the only biomarker whose level increased more in patients who had received high levels of PEEP. CONCLUSION: In patients undergoing abdominal surgery and at risk of developing PPCs, plasma levels of biomarkers for inflammation or lung injury showed distinct kinetics with development of PPCs, but none of the biomarkers showed sufficient prognostic value. The use of high levels of PEEP was associated with increased levels of CC-16, suggesting lung overdistension. TRIAL REGISTRATION: The PROVHILO trial, including this substudy, was registered at clinicaltrials.gov (NCT01441791).

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Personal electronic device use in the operating room: A survey of usage patterns, risks and benefits

No abstract available

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Adverse effects of hyperchloraemic solutions

No abstract available

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Retraction: Comparison of four facial muscles, orbicularis oculi, corrugator supercilii, masseter or mylohyoid, as best predictor of good conditions for intubation: A randomised blinded trial. Lee HJ, Kim KS, Jeong JS, et al.

No abstract available

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Papilla and alveolar crest levels in immediate versus delayed single-tooth zirconia implants

Publication date: Available online 1 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): K. Kniha, H. Kniha, S.C. Möhlhenrich, S. Milz, F. Hölzle, A. Modabber
The aim of this study was to determine the correlation between the papilla deficit and the distance between the bone crest at the neighbouring tooth and the contact point of the clinical crown (distance 4) for immediate and delayed zirconia implants. This prospective observational study included 78 patients with 82 implants investigated at the 1-year follow-up. Patients received single-unit zirconia implants (Straumann PURE Ceramic Implant with ZLA surface) that were placed using either the delayed (group A) or immediate (group B) protocol after tooth extraction. The distance of the alveolar crest of the neighbouring tooth to the height of the interdental papilla and the absence of the papilla were also assessed. There was a strong correlation between the papilla deficit and distance 4 in group A (Spearman's rho=0.64). However, in group B, only a weak correlation between the two distances was found (Spearman's rho=0.28). A full soft tissue margin was generated when distance 4 was 7–8mm or less. Delayed implant placement showed a critical distance between the alveolar crest at the neighbouring tooth and the contact point of the crown risking a visible papilla deficit of between 7mm and 8mm.



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Additively manufactured sub-periosteal jaw implants

Publication date: Available online 1 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.Y. Mommaerts
Severe bone atrophy jeopardizes the success of endosseous implants. This technical note aims to present the innovative concept of additively manufactured sub-periosteal jaw implants (AMSJIs). Digital datasets of the patient's jaws and wax trial in occlusion are used to segment the bone and dental arches, for the design of a sub-periosteal frame and abutments in the optimal location related to the dental arch and for the design of the suprastructure. The implants and suprastructure are three-dimensionally (3D) printed in titanium alloy. The provisional denture is 3D-printed in polymer. AMSJIs offer an alternative approach for patients with extreme jaw bone atrophy. This report refers to the use of this technique for full maxillary rehabilitation, but partial defects in either jaw and extended post-resection defects may also be approached using the same technique. This customized, prosthesis-driven reverse-engineering approach avoids bone grafting and provides immediate functional restoration with one surgical session.



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Influence of third molars in mandibular fractures. Part 2: mandibular condyle—a meta-analysis

Publication date: Available online 1 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.C.V. Armond, C.C. Martins, J.C.R. Glória, E.L. Galvão, C.R.R. dos Santos, S.G.M. Falci
The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle–Ottawa scale assessment. The presence of a mandibular third molar decreased the probability of condylar fracture (cross-sectional and case–control studies: odds ratio (OR) 0.26, 95% confidence interval (CI) 0.17–0.40, I²=87.8%; case–control studies: OR 0.30, 95% CI 0.16–0.58, I²=91.6%). The third molar positions most favourable to condylar fracture according to the Pell and Gregory classification are class A (OR 1.32, 95% CI 1.09–1.61, I²=0%) and class I (OR 1.37, 95% CI 1.05–1.77, I²=32.8%). Class B (OR 0.69, 95% CI 0.49–0.97, I²=56.0%) and class II (OR 0.71, 95% CI 0.57–0.87, I²=0%) act as protective factors for condylar fracture. The results suggest that the presence of a mandibular third molar decreases the chance of condylar fracture and that the positions of the third molar most favourable for condylar fracture are classes A and I, with classes B and II acting as protective factors.



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